TORONTO - Nurse practitioners are steadily gaining ground in Canada, according to a snapshot of nursing that shows overall growth of the workforce.

An annual report released Thursday by the Canadian Institute for Health Information said there were 354,910 regulated nurses working in Canada in 2010, an increase of 8.8 per cent since 2006.

"Between 2009 and 2010, the nursing supply increased by two per cent, so if you look at the population, it increased by one per cent approximately, so we're seeing double the growth there," said Carol Brule, the institute's manager of health human resources.

The report on the supply of registered nurses, licensed practical nurses, nurse practitioners and registered psychiatric nurses is important for planning and policy decision-makers, she said.

Nurse practitioners have extra training that allows them to order certain diagnostic tests, perform some procedures and prescribe drugs and other therapies. Although their ranks are still small, the report shows they increased by 25 per cent in 2010, to 2,486.

Brule called it an "emerging profession" with a complementary role.

"They can work as part of health-care teams. They certainly have a very key role to play — they can support the work of physicians," Brule noted.

Canadian Nurses Association president Judith Shamian said it goes back to a simple message that there are about five million Canadians who don't have access to primary care — and nurse practitioners can provide that service.

She heralded the size of the increase in Ontario but said growth has been slower in other provinces.

"So the 25 per cent — hallelujah! Do we need to keep up the 25 per cent? We need to keep it up until all Canadians have proper access, and not just access, but timely access."

She also welcomed the overall growth in the nursing supply, but indicated nothing is simple in analysis of the statistics.

A report from her association a couple of years ago projected a growing shortage of nurses, yet the situation is confusing because there are nurses who say they cannot find full-time jobs.

"So it's kind of a mixed bag of things," Shamian said from Ottawa. "You will find in most organizations a fair amount of vacancies, but they might not be desired positions."

Shamian said she often hears that new graduates are working in multiple clinical areas or at more than one institution to pay their bills — making it more difficult to gain expertise in a specific discipline.

"You cannot become an expert if one day you work in maternity, the other day you work in the long-term care, and then you are in emergency room," she said, referencing the phrase "jack of all trades, master of none."

"So it's not the way to build an important workforce and a professional workforce. So yes, we have a lot more work to do in this area."

She said that in some provinces, it's difficult to recruit home care nurses because the salaries are often lower than in acute care.

"The number of registered nurses working in long-term care went down which is not good, because the people who go into long-term care facilities are sicker and sicker," she noted.

"But it's not clear to me if the numbers went down because there are vacancies or because long-term care facilities are replacing registered nurses with practical nurses, which are a cheaper workforce.

"And if that's the case, then it's a policy problem."

In terms of mobility, Brule said the "magnet provinces" of British Columbia, Alberta and Ontario were the top three destinations for work for Canadian-educated nurses who left their jurisdiction of graduation.

The age for nurses entering the workforce is often 30 or older, she said, and the 40-to-59 age group dominates the profession.

A breakdown shows that three-quarters of regulated nurses were RNs in 2010, while 23 per cent were licensed practical nurses and 1.5 per cent were registered psychiatric nurses. Those proportions have remained steady for the last five years.

There were 787 registered nurses per 100,000 population in Canada in 2010, the report said. In the early 1990s, there were 824 RNs per 100,000 population — a ratio that has not been achieved since that time.

Shamian said she's concerned that the number of managers has been going down every year.

"A manager — we have research — should be providing leadership to anywhere between 40 to 50 individuals, and if you don't have managers, then they cannot nurture and help the new graduates," she said.

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